ICU SAQs · Infection / oncology
Febrile neutropenia — 1 hour of triage
CICM SAQ on febrile neutropenia: ASCO/IDSA 1 hour of triage, anti-pseudomonal beta-lactam, selective vancomycin, Walsh empirical antifungal, G-CSF as prophylaxis.
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Prompt
A 50-year-old, 10 days post-chemotherapy for AML, presents with fever 38.8 and rigors. Neutrophils 0.3. Discuss the immediate management.
Question
A 50-year-old, 10 days post-chemotherapy for AML, presents with fever 38.8 and rigors. Neutrophils 0.3. Discuss the immediate management.[1]
References6ShowHide
- [1]Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America Clin Infect Dis, 2011.PMID 21258094
- [2]Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update J Clin Oncol, 2018.PMID 29461916
- [3]Nates JL, Pène F, Darmon M, et al. Septic shock in the immunocompromised cancer patient: a narrative review Crit Care, 2024.PMID 39215292
- [4]Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia N Engl J Med, 2004.PMID 15459300
- [5]Kuderer NM, Dale DC, Crawford J, Lyman GH. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review J Clin Oncol, 2007.PMID 17634496
- [6]Smith TJ, Bohlke K, Lyman GH, Carson KR, et al. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update J Clin Oncol, 2015.PMID 26169616